Value vs. volume?
Patient volume is up, and will most likely continue, especially as more and more baby boomers turn 65. In fact, a recent study by the consulting firm MedAxiom showed that cardiologists reported seeing on average 329 new patients in 2009 alone, driving the need for greater specialist care.
However, Joseph E. Marine, MD, associate professor of cardiology and director of arrhythmia services at the Johns Hopkins Bayview Medical Center in Baltimore, told me recently that the overall population seems to be getting healthier, at least in terms of cardiovascular disease. Despite the fact that many are stricken with comorbidities, there has been a decreased need for implantable cardioverter-defibrillators (ICDs) and coronary stents.
Marine offered that therapies such as statins, etc., may be thwarting the extent of cardiovascular disease in some patients, but said that we may need more specialists to focus on preventive care and aging in general.
This brings us to the million dollar question: Will there be enough cardiologist volume to care for this growing patient demand? While purely speculative at this point, some mounting evidence has shown the influx of new cardiologists is falling drastically, leaving doubts about whether the supply will meet the demand.
This week I spoke with Ernst R. Schwarz, PhD, of Cedars-Sinai Heart Institute in Los Angeles, who told me that a center performing more heart transplants speaks volumes compared with those that are under the radar in terms of the Medicare standard of 10 procedures per year.
To add to that statement, copious data have shown that lower operator volumes may affect patient outcomes. For instance, a study this past September showed that early experience performing carotid artery stenting and those centers that had lower operator volumes saw heightened 30-day mortality rates. Additionally, a study this week found those undergoing orthotopic heart transplantation at high-volume centers (those that perform more than 15 procedures per year) had better outcomes.
With the help of registries to track outcomes and volume, in addition to guideline recommendations for the volumes required for certain procedures, we may be able to crack the code to better care. But will various volume equations in the healthcare industry offset each other, or leave cardiologists grasping at straws?
Check out our feature story in our April magazine for a more in-depth look of the possible cardiologist shortage.
Cardiovascular Business, associate editor